OHSU StudentSpeak » preceptorshiphttp://www.ohsu.edu/blogs/studentspeak
Who better than the students to describe what being a student at OHSU is all about?Tue, 15 Nov 2016 17:43:47 +0000en-UShourly1http://wordpress.org/?v=4.2.10Preceptorship!http://www.ohsu.edu/blogs/studentspeak/2015/02/09/preceptorship/
http://www.ohsu.edu/blogs/studentspeak/2015/02/09/preceptorship/#commentsMon, 09 Feb 2015 17:00:45 +0000http://www.ohsu.edu/blogs/studentspeak/?p=6892Read More]]>One of the big draws to OHSU for me was the preceptorship program. I was a medical scribe for 2 years previous to medical school, and I love clinical medicine. You meet all kinds of wonderful and interesting people, and although science is somewhat predictable, people are highly variable. So, I was super excited to start my preceptorship and get some patient contact.

My preceptor is a pediatric neurosurgeon. I was initially disappointed, as she does mostly surgeries on the day I have available to work with her, and I was looking forward to talking with patients. That said, I had no previous exposure to the OR, and neurosurgery was well outside my comfort zone, so I knew I would learn a lot. On my first day, I watched brain surgery. Who else gets to do that? I had to reach deep to remember brain anatomy, but fortunately one of her residents was able and willing to explain what I was seeing as she was operating. Our patient was already intubated and anesthetized by the time I arrived, but I got a good look at the multiple layers covering the brain, and the soft, squishy tumor occluding the flow of CSF between brain and spinal cord. When I accompanied her to see our patient’s parents after the surgery, they discussed a few presenting symptoms, including personality changes and cognitive impairment, which helped me to get a fuller view of this patient.

The brain is necessary for our continued survival in both a physical and a more esoteric sense, which is unique among all the organs. That gray matter houses who we were, who we are today, and who we will be tomorrow. As I thought about it later, the exposed brain during surgery not only pulsed with blood and electricity, but also our patient’s life force. My doctor handled the brain gently but confidently, making incremental and patient progress until all visible traces of the tumor were removed. I fervently hope that her work saved our patient’s mind and body both, and gave him/her a future that they would otherwise not have had.

Medical specialties can be loosely divided into more physical and more mental disciplines. Surgeons use their hands to treat, while internists use their minds. I enjoy the puzzle, connecting patient symptoms to physical findings in order to arrive at a diagnosis. I also enjoy learning about individuals and thinking about how to connect a treatment plan to an individual’s goals. Medicine should not be about curing the disease, it should be about helping patients to live their life in the fullest and healthiest possible way.

That was the exact question I was asking myself when I started medical school and even up until my first day at the clinic. There isn’t a very good definition on Wikipedia and it’s definitely not in ye ole trusted Miriam Webster. Even asking older students led to a multitude of definitions ranging from “glorified shadowing” to “being a doctor’s assistant.” Both of which were not entirely satisfying. It wasn’t until I started a couple weeks ago, that I uncovered what a preceptor was: a role model for patient interaction.

It’s difficult to learn how to build a relationship with a patient or deliver bad news purely from reading journal articles and practicing with classmates. Reading evidence-based practices for introducing yourself and shaking hands is helpful, but not the same as doing it with someone you’ve just met. Sitting down and setting an agenda for a fake patient interaction with your friend that you spent all of last night studying metabolism with, is not the same as starting your first conversation with a patient. As much as you pretend to not know each other and create that reality, you can’t help but talk about that one quiz question from last week or your fellow classmate’s birthday dinner tomorrow night. It’s great practice – with your classmates you can feel free to completely mess up, to forget a couple points and try out new questions – but not the same as sitting down with someone who is genuinely sick or in terrible pain and trying to communicate with them. Class gives you the tools to communicate with patients, but preceptorship allows you to watch a professional do what you’ve spent weeks practicing with style and grace.

In my preceptorship, we work with many people who are needing end-of-life care. Most of our patients are very sick and have been sick for a number of years. Many times a patient will already have their diagnosis so our main priority is to provide support during their lengthy treatment. On rare occasion, we need to have a hard conversation starting with “we noticed a suspicious mass on your latest CT scan.” It’s through these few encounters, though, that I’ve learned the most about being an empathetic doctor and have seen human resilience in action. I’ve learned about the power of touch and lending a sympathetic ear to someone who is merely trying to understand their new diagnosis. I’ve seen how speaking the simple statement “I am here for you, we are here for you, you are not alone in this,” can take someone whose outlook on life was utterly hopeless – their shoulders slumped from the weight of endless minutes of data and treatment options, their eyes glued to the floor as if the answer to their problems would be carved into the tile of the exam room, their faces immediately aged 20 years and simultaneously frozen in time, completely and utterly stunned – and completely turn it around. That ability to inspire hope is truly magical. That’s not something that you can learn in a book; it’s something you learn from a role model.

Nothing compares to the first time you step into a patient’s room alone to talk to them, only to mispronounce the word “auscultate” out of sheer nervousness and then bond with them because of it, or the satisfaction of seeing a smile on your preceptor’s face after producing a thorough history. So what is a preceptor? A preceptor is a role model for being an empathetic, caring professional, and I am so grateful to have this opportunity.

Prior to PA school, I primarily worked as a pathology technician performing gross dissections (in the macroscopic sense, but often in the literal sense too) of human tissue in Anatomic Pathology. I could slice my way through gallbladders like it was nobody’s business, releasing that sludgy green-brown material known as bile that lets french fries, cheese and everything sacred exist in my diet. I could describe every minute detail of a perforated appendix on my pathology reports, forming a word-picture vivid enough that my supervising pathologist would rarely have to re-examine my work. I was GOOD at my job – and then I came to PA school.

OHSU’s 2000-hour direct patient care requirement, the equivalent of 12 months of full-time work, was daunting to a lab rat like me. I felt like I was constantly counting down from 2000 to satisfy the pre-req. During this summer quarter, most members of our class awkwardly clutched oto-/naso-/opthalmoscopes because very few of us had ever used the equipment before. Where I first felt a divide with my lab background was when we learned how to take a history of present illness. My classmates who were EMTs, paramedics, MAs, ER scribes and CNAs seemed to have the medical interview roll off of the tips of their tongues. By far, exploring the seven dimensions of an HPI has been the most challenging aspect for me as a PA student. In the lab my “patients” were tissue and had I started talking to them, it would’ve been a clear sign that I had enough formalin exposure for the day.

Jump ahead to fall quarter and our clinical medicine coursework is now in full swing. Week after week we’re required to know a different laundry list of illnesses accompanied by their etiology, signs & symptoms, diagnostic work-up, treatment and patient education. I was glad to have the clin med courses “distract” me from my so-so medical interviewing. Each Friday morning exam rolls around, our classmates on the morale committee blast the Top Gun theme song, “Eye of the Tiger,” or some other pump-up music that belongs on Barney Stinson’s “Get Psyched” mix CD, and we test together. I’m not saying that we take group exams, but the environment somehow feels like all 43 of us are rooting for each other and not just ourselves.

During one particular week, our exam tested us on diarrhea and urinary tract infections in depths that I never cared to know. Fried rice and cottage cheese? Yup, both are dead to me now – but I digress. After that exam, I hopped into my car and drove to my Urgent Care preceptorship. My PA mentor pulled the next chart on deck and read: “chief complaint: It burns when I pee.” He asked if I wanted to fly solo for the H&P and after a week of hammering UTIs into my brain, I couldn’t have asked for better timing. I entered the exam room by myself and a photographic image of my UTI study table flashed at the front of my brain. I asked about symptoms, ruled items on my differential in and out, explained the urine dipstick results, and performed a problem-oriented abdominal exam. For the first time in 16 weeks that we’ve been in school, I felt like I was having an actual conversation with my patient regarding their health and was confident about my interviewing skills. However small it may seem to the seasoned provider, it truly was a proud moment of mine and I felt like I could have diagnostically tackled every patient that day…as long they had some sort of UTI.

As a future PA, I want to give people quality medical care and I want to be great at it. It’s the core reason why I chose to become a Physician Assistant. But at this point in time, I have to accept the fact that I may not even be good at it. At least not yet, or on the first try. A year ago to the day, I received that life changing phone call with an offer to attend Oregon Health & Science University. The transition of being an “expert” in the pathology lab a year ago to a student was, and still is, nothing short of frustrating. But over the past 16 weeks, I’ve learned so much from my professors and possibly more from my classmates. The juxtaposition of how much we do know and how much we still don’t know is quite incredible. We study together, we test together, we happy-hour together. At some point in the program, the work experience clock resets for all of us and it’s an even playing field. After all, didactic year is 12 months of challenging full-time work. So here we are again: T-minus 2000 hours, until clinical year.